What happens when the payer pays?

This is the happy path. The payer answers, the money posts, and the claim closes out cleanly.

Say you billed 150 dollars for an office visit. The payer’s remittance comes back and the Payments section on the claim fills in, decoded into plain numbers:

• Billed: 150 dollars. What you asked for.
• Paid: 95 dollars. What actually arrived.
• Write-off: 40 dollars. The contractual difference, carrying code CO-45, because the charge was over the allowed amount. Nobody owes it.
• Patient responsibility: 15 dollars. The copay, carrying code PR-3.

Every dollar of the 150 is accounted for: 95 plus 40 plus 15. That is what a clean answer looks like, and it is worth checking that the three numbers add up to what you billed.

The only piece left is the patient’s 15 dollar copay, collected at the front desk. With that collected, the claim reads Paid.

If a code is a mystery, ask. The assistant reads the payer’s answer and explains the write-off in one plain sentence, and tells you exactly what the patient still owes.

Not every answer is this tidy. See Why does the patient owe the whole bill? and Why is this check short?.